Prospective study of the long-term effects of somatostatin analog (octreotide) on gallbladder function and gallstone formation in Chinese acromegalic patients.

Abstract

This article reports the changes in gallbladder function examined by ultrasonography in 20 Chinese patients with active acromegaly treated with sc injection of the somatostatin analog octreotide in dosages of 300-1500 micrograms/day for a mean of 24.2 +/- 13.9 months. During treatment with octreotide, 17 patients developed sludge, 10 had gallstones, and 1 developed acute cholecystitis requiring surgery. In all of 7 patients examined acutely, gallbladder contractility was inhibited after a single 100-micrograms injection. In 8 patients followed for 24 weeks, gallbladder contractility remained depressed throughout therapy. After withdrawal of octreotide in 10 patients without gallstones, 8 patients assessed had return of normal gallbladder contractility within 1 month. In 8 of the remaining 10 patients who developed gallstones during treatment, gallbladder contractility normalized in 5 patients (3 of whom has disappearance of their stones within 3 weeks), and remained depressed in 3 (2 of whom had stones present at 6 months). Our results suggest that the suppression of gallbladder contractility is the cause of the successive formation of bile sludge, gallstones, and cholecystitis during octreotide therapy in Chinese acromegalic patients. It is therefore very important to follow the changes of gallbladder function during long-term octreotide therapy of acromegalic patients.

Combination treatment with somatostatin analogues and pegvisomant in acromegaly

“…There are two well-known types of hepatic enzyme disturbance: hepatocellular and cholestatic. Cholestatic disturbances are most often related to treatment with LA-SRIF analogues [5,6,10,42]. During LA-SRIF, a significant proportion of these patients have asymptomatic biliary stones, but active disease is rare [42].…”

Cholelithiasis and acromegaly: therapeutic strategies

“…However, increasing evidence indicates that octreotide may be associated with a high risk of developing gallstones (Gordon et al, 1989;Wass el al., 1989;McKnight et a/., 1989McKnight et a/., , 1991Wass, 1990;Plijckinger ef a/., 1990;Shi et a/,, 1990Shi et a/,, , 1992Catnach et al, 1993) even though they are generally asymptomatic (Tauber et al, 1989;McKnight et a/., 1989;Jackson, 1989;Ho et al, 1990Shi et al, 1990Eastman et a!., 1992).…”

Restoration of gallbladder contractility after withdrawal of long-term octreotide therapy in acromegalic patients

“…The most likely explanation is that octreotide decreases contractility of the gallbladder (10). The most likely explanation is that octreotide decreases contractility of the gallbladder (10).…”

“…The most likely explanation is that octreotide decreases contractility of the gallbladder (10). In either case, bile stasis appears to be the central mechanism contributing to gallstone formation (10). In either case, bile stasis appears to be the central mechanism contributing to gallstone formation (10).…”

“…However, there have been reports that treatment with octreotide is associated with an increased incidence of cholelithiasis (7)(8)(9). We addressed this issue by prospectively observing changes in gallbladder function in 20 acromegalic patients during long-term treatment and found that gallbladder contractility was inhibited in all patients and that gallstones had formed in 50% (10). As octreotide represents a very useful therapeutic agent in the medical treatment of acromegaly, it is important to find an approach to avoid gallbladder dysfunction during longterm treatment.…”